基于吞咽障碍造影评分量表半定量评估法的脑卒中后吞咽功能相关影响因素分析

关键词：脑卒中  吞咽障碍  影响因素  吞咽障碍造影评分量表

Keywords:stroke  swallowing disorder  influencing factors  videofluoroscopic dysphagia scale

摘要：

      摘要 目的：基于吞咽障碍造影评分量表（VDS）半定量评估法探究脑卒中后吞咽功能的影响因素，为临床筛查和治疗提供依据。 方法：采用回顾性调查方法，共纳入符合入选标准的脑卒中患者120例。收集每例患者的临床特征，包括性别、年龄、卒中类型、病灶部位、病程、食物性状、留置胃管及气管切开、伴随疾病等；所有患者均进行了吞咽造影（VFSS）检查，使用VDS进行吞咽功能评分，并用单因素和多因素线性回归分析探究临床特征对口腔期、咽期及整体吞咽功能的影响。 结果：①单因素分析显示，大脑中动脉（MCA）皮质下（除基底节以外）区域病变（P<0.001）、基底节区域病变（P=0.040）及延髓病变（P<0.001）是脑卒中后整体吞咽功能的影响因素。②多因素线性回归分析显示，延髓（P<0.001）、MCA皮质下区域（除基底节以外）病变（P<0.001）及MCA（包括基底节）区域病变（P=0.019）是卒中后整体吞咽功能的危险因素；对于食物性状，使用浓流质和糊状物进食是卒中后整体吞咽功能的保护因素。③对整体吞咽功能进行亚项分析表明，MCA（包括基底节）区域病变（P=0.003）、女性（P<0.001）和气管切开（P<0.001）是卒中后口腔期吞咽功能的危险因素；相较于非留置胃管，留置胃管（P=0.034）对口腔期吞咽功能的影响更小；相较于脑出血，脑梗死（P=0.004）对口腔期吞咽功能影响更小；延髓（P<0.001）和MCA皮质下（除基底节以外）区域病变（P<0.001）是卒中后咽期吞咽功能的危险因素；对于食物性状，使用浓流质（P=0.005）和糊状物（P=0.002）进食是卒中后咽期吞咽功能的保护因素。 结论：在脑卒中患者吞咽功能评估中，对临床特征的识别有助于确定吞咽障碍类型及治疗重难点，制定并实施更具针对性的康复治疗方案，加快恢复脑卒中患者的吞咽功能和摄食能力。

Abstract:

      Abstract Objective： To explore the influencing factors of swallowing function after stroke based on the semi-quantitative assessment of the videofluoroscopic dysphagia scale （VDS）， to provide a basis for clinical screening and treatment. Method： A retrospective survey method was conducted on 120 stroke patients who met the inclusion criteria. Clinical characteristics were collected， including gender， age， type of stroke， lesion location， disease duration，food consistency， nasogastric tube placement， tracheostomy， and comorbidities. All patients underwent a videofluoroscopic swallowing study （VFSS）， and swallowing function was assessed using the videofluoroscopic dysphagia scale （VDS）. Univariate and multivariate linear regression analyses were conducted to examine the effects of clinical characteristics on oral phase， pharyngeal phase， and global swallowing function. Result： Univariate analysis revealed that subcortical lesions in the middle cerebral artery （MCA） region （excluding the basal ganglia） （P<0.001）， basal ganglia lesions （P=0.040）， and medullary lesions （P<0.001） were significantly associated with global swallowing function after stroke. Multivariate linear regression analysis indicated that medullary lesions （P<0.001）， subcortical lesions in the MCA region （excluding the basal ganglia） （P<0.001）， and MCA （including basal ganglia） lesions （P=0.019） were risk factors for global swallowing function after stroke. Regarding food consistency, consumption of thickened liquids （P=0.018） and pureed foods （P=0.006） were protective factors for global swallowing function. Subgroup analysis of global swallowing function revealed that MCA （including basal ganglia） lesions （P=0.003）, female gender （P<0.001） and tracheotomy（P<0.001） were risk factors for oral phase swallowing function after stroke. Compared with patients without a gastrostomy tube， those with a gastrostomy tubes （P=0.034） had less effect on swallowing function in the oral phase. Compared with hemorrhagic stroke， ischemic stroke （P<0.001） had a less impact on the oral phase swallowing function. Medullary lesions （P<0.001） and subcortical lesions in the MCA region （excluding the basal ganglia） （P<0.001）were risk factors for pharyngeal phase swallowing function. For food consistency， the consumption of thickened liquids （P=0.005） and pureed foods （P=0.002） were protective factors for pharyngeal phase swallowing function after stroke. Conclusion： Identifying clinical characteristics in the assessment of swallowing function in stroke patients helps to determine the type of dysphagia and the key points of treatment. This approach may facilitate the development and implementation of more targeted rehabilitation treatment plans， and accelerate the recovery of swallowing function and feeding ability in stroke patients.